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Dental Public Health Activities: Descriptive Summaries

Massachusetts Department of Public Health SEAL Program

Practice Number: 24006
Submitted By: Massachusetts Department of Public Health, Office of Oral Health
Submission Date: September 2009
Last Reviewed: October 2011
Last Updated: October 2011
Best Practice Approach Example Massachusetts Department of Public Health SEAL Program

The Massachusetts Department of Public Health (MDPH) developed the MDPH-SEAL (Seal, Educate, Advocate for Learning) Program, a school-based oral health prevention program to serve MassHealth eligible and other high-risk school-age children and youth. The goal of the SEAL Program is to improve their oral health by increasing their access to preventive dental services (dental sealants and topical fluoride), and reduce oral health disparities.

The dental professionals supporting the MDPH-SEAL Program consist of registered dental hygienists (3.2FTE), two oral health prevention specialists (1.6FTE), and. one licensed dentist (o.2FTE), who is also Director of one of the state’s public health hospital dental programs. The staff dentist provides general supervision for the program’s dental hygienists through a standing order allowing the hygienists to place dental sealants without first having a dental examination. The dental hygienists work closely with school nurses and nurse practitioners in the school-based health centers to coordinate the MDPH-SEAL Program and to implement a case management program for dental referrals.

The program serves high-risk children and those enrolled in the MassHealth (Medicaid/SCHIP) Program. MDPH-SEAL targets schools with (1) schools with at least fifty-percent free and reduced school lunch participation: (2) schools in communities with more than 15,000 MassHealth eligible children; (3) schools with school-based health centers; and (4) schools located in dental health professional shortage areas. While the program targets children in grades 2, 6, 7 and 9; it is open to any child within a participating school with permission to participate.  In school-year 2011-2012, the Program is serving school-age children and youth in 130 schools in 12 different Massachusetts communities.

Dental hygienists provide screenings, administer dental sealants and fluoride varnish, provide referrals for restorative treatment and other dental needs, and follow-up as needed with both school nurses and parents.

All dental services are delivered with portable dental equipment and all children may participate regardless of their insurance status or the family’s ability to pay.   Since its inception in 2006, the program was supported with competitive HRSA funding and some state dollars. In school year 2011-2012, the Department of Public Health Office of Oral Health became a MassHealth dental provider, allowing the Program to receive direct reimbursement from this pubic insurance program ensuring its sustainability. 

The Program collaborates with the state’s public health hospital dental programs, community health center dental programs, and private dental providers to assure resources for restorative treatment and other dental care is available.

MDPH-SEAL also uses the CDC’s Sealant Efficiency Assessment for Locals and States (SEALS) benchmarking tool to demonstrate the cost-effectiveness of the prevention services delivered through the Program, as well as sealant retention rates and access to restorative treatment.

The MDPH-SEAL Program has increased the number and/or level of:

  • High-risk children having access to dental prevention services;
  • Care coordination for children identified with untreated tooth decay;
  • Awareness and knowledge of oral health by students, parents, teachers and school administration;
  • Integration of oral health in general health and wellness activities in schools;
  • Collaborations to support and expand oral health prevention programs;
  • Oral health programs in school-based health center schools

Lessons Learned:

School nurses are front-line providers and they manage children for a wide range of health issues including oral health problems. School nurses play a key-role in the success of school-based and school-linked health

School nurses and nurse practitioners are front-line providers, managing school-age children  and youth for a wide range of health issues including oral health problems. They play an important role in the promotion of school oral health programs and have the ability to support the expansion of these programs to serve the students at highest-risk. Active and continuous communication with the school nursing staff is imperative to the success of a school-based oral health program.

Teachers and administration are also key allies in the success of an oral health program. Oral health education regarding the need for preventive services and good oral health is needed with this group of individuals. The better the staff understands the goals of the program and the basic goals of good oral health, the better equipped they are to support and advocate for oral health programs with the students and the students’ parents.

Not only is a small incentive fun to provide to a student who returns a consent form to help ensure that the services is wanted or not, but incentives to support staff in the schools, especially teachers and nusres, is a very effective way to increase participation and the return rate of consent forms.

Contact Person(s) for Inquiries:

Lynn Bethel, RDH, MPH
Director, Office of Oral Health
Massachusetts Department of Public Health
250 Washington Street, 5th Floor
Boston, MA 02108
Phone: 617-624-6074
Fax: 617-624-6062

Marlene Barnett, RDH, MPH, Community Oral Health Prevention Specialist, Office of Oral Health, Massachusetts Department of Public Health, 250 Washington Street, 5th Floor, Boston, MA 02108, Phone: 413-586-7525, Fax: 617-624-6062, Email: